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A-1388
2004 |
| Surgical Site Infection Prevention - Improved Guideline Compliance through O.R. Process Improvement |
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Morris Brown, M.D., William Conway, M.D., Jack Jordan, Ph.D., Barbara Horvath, R.N., Henry Kroll, M.D. Department of Anesthesiology, Henry Ford Hospital, Detroit, Michigan. |
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Introduction: Surgical site infections (SSIs) are a major cause of patient injury, mortality, and health care cost. An estimated 2.6% of the nearly 30 million operations each year are complicated by SSIs, and patients with infections have twice the incidence of mortality, and increase the cost of hospitalization by $130-$845 million per year1. As part of a Centers for Medicare and Medicaid Services sponsored national demonstration project on surgical site infection prevention, we used rapid-cycle improvement methods to increase compliance with published guidelines known to reduce SSIs. Areas targeted included preparation of the surgical site, selection, dosing, and timing of prophylactic antibiotic administration, maintenance of normothermia, and glycemic control. Methods: A surgical site infection prevention team was convened to improve patient care for patients undergoing surgery at our institution. Guidelines were applied to selected surgical services, and then expanded to all surgical patients. From 5/02 to 1/04, O.R. records were audited for compliance with approved infection control guidelines. Through rapid-cycle improvement methods, the SSI prevention team suggested and implemented changes to improve results. The number of cases between SSIs was used as the monitor for infection rates. Results: The compliance with the use of clippers in place of razors for preparation of the surgical site went from 87.5% to 100%. Appropriate antibiotic selection improved from 87.6% to 96.5%. On-time administration of prophylactic antibiotics started at 12.5% and improved to 95.6%. The percentage of time prophylactic antibiotics were stopped at 24 hours was initially 77.4% and increased to 100%. Appropriate timing of an indicated second dose of antibiotics went from 75.3% to 93%. The percent of glucose values between 80 and 150mg% went up from 30% to 65%, and readings above 250mg% dropped from 20% to less than 5%. The aggregate measure of compliance with the surgical infection prevention bundle (100% compliance with all measured guidelines) is outlined in Figure 1. Discussion: Implementation of Category 1 recommendations outlined by the Hospital Infection Control Practices Advisory Committee in the CDC guidelines for SSI prevention2 is an essential part of reducing infections in the O.R. Process redesign, SSI surveillance with feedback to surgeons, and having anesthesiologists take a leadership role in the process, significantly improved compliance with published guidelines and thereby reduces the risk of SSIs. References: 1. Jarvis WR: Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol. 1996, 17:552-7. 2. Mangram AJ, Horan TC, Pearson ML, et al: Guidelines for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999, 20:247-78. Anesthesiology 2004; 101: A1388 |
Figure 1
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